Predictive Factors Associated With Success of High-Flow Nasal Cannula (Hfnc) for Covid-19 Related Acute Hypoxemic Respiratory Failure in King Narai Hospital, Lopburi

บทคัดย่อ

Objective: The purpose were to assess patient characteristics on IMCU admission, clinical course, outcomes and examine COVID-19 patients with acute hypoxemic respiratory failure (AHRF) in order to identify factors associated with HFNC success

          Method: The researchers performed a single center, retrospective cohort study in King Narai Hospital from April 1 to September 30, 2021 by enrolling 76 patients with AHRF from 1,934 confirmed COVID-19 admitted in the hospital. Patients were assigned to two groups based on HFNC success 45 patients and HFNC failure 31 patients.

          Result: Mean age of enrolled patients was 56.2 years, 46 (60%) with DM were identified. The subjects with aging (>60 years) and ones with Risk factors ≥ 2 factors were associated with HFNC failure (p = .019, p = .028, respectively). Patients with HFNC success had a higher median of SpO₂/FiO₂ at 48 hr (178 % vs. 103%, p < .001) a significant lower median of CRP at initial IMCU admission and at 48 hr (93.5 vs. 134.3 mg/L, p = .001; 24 vs. 61.5 mg/L, p = .001; respectively), and a lower median of D-dimer (633 mcg/ml vs. 3,259 mcg/ml, p = .001). The success group also had a higher average ROX index at 6, 12, and 24 hr (p = .002, p < .001, and p < .001, respectively). Success HFNC was found in patients who initiated Favipiravir < 4 days of clinical manifestation and who were on intravenous Methylprednisolone 250 mg at ICU/IMCU admission (p = .043, p = .044, respectively). Median Hospital Length of Stay in success HFNC patients was 15 days, significantly shorter than the failure group (18 day, p < .036).

          Conclusion: HFNC is effective to treat COVID-19 patients with AHRF who have predictive factors of HFNC therapy success. HFNC is safe to use in acute hospital at other ward outside ICU.